Cancer is defined as the uncontrolled growth of cells in the body. Pancreatic cancer occurs when cells in the pancreatic gland proliferate uncontrollably. The pancreas is a fish-shaped organ located horizontally behind the stomach, approximately 15 cm long and 4-5 cm wide. Its head is on the right side of the abdomen, right next to the duodenum, its body is in the middle of the abdomen, behind the stomach, and its tail is on the left side of the abdomen, directly related to the spleen.
There are two groups of satellite cells in the pancreas:
Exocrine cells: These cells secrete enzymes involved in the digestion of food. Enzymes secreted into the pancreatic ducts combine with the main bile duct and are poured into the 12-finger intestine.
Endocrine cells: These cells, which form a smaller part of the pancreas, secrete important hormones such as glucagon and insulin directly into the bloodstream.
Types of Pancreatic Cancer
Different types of cancer originating from pancreatic exocrine and endocrine cells can be seen. Risk factors, diagnosis and treatment approaches may be different for these two different types.
Pancreatic adenocarcinomas: They constitute 95% of pancreatic cancers. They usually develop from the pancreatic ducts.
Ampulla of Vater Cancer: The area where the pancreatic duct meets the bile duct and flows into the duodenum is called Ampulla of Vater. Although cancers that develop in this region are not technically pancreatic cancer, their diagnosis and treatment approaches are no different from adenocarcinomas. Ampulla Vater cancers are diagnosed at an early stage because they quickly block the bile ducts and cause jaundice. In this respect, their prognosis (survival time) is better after treatment compared to other pancreatic cancers.
Racker pancreatic exocrine tumors: Adenosquamous cancers, squamous cell cancers, signet ring cell cancers and undifferentiated cell cancers.
Pancreatic endocrine tumors: They constitute less than 5% of pancreatic cancers. They are called Pancreatic Neuroendocrine Tumors (NET) or Islet Cell tumors. They are divided into two as functional or unfunctional according to their hormone production.
Functional pancreatic NETs:
Gastrinoma, Insulinoma, Glucagonoma, Somatostatinoma, VIPo. ma, PPoma
The most common pancreatic NETs are gastrinomas and insulinomas.
Benign and Precancerous Pancreatic Masses:
Serous Cystic Neoplasias: Serous cystic neoplasias are cysts containing serous fluid in the pancreas. They almost always tend to be benign. They should be treated when they cause symptoms such as pain in the patient.
Mucinous Cystic Neoplasias: These cystic tumors, which are generally seen in women, are sacs containing gelatinous fluid called mucin. Their risk of turning into pancreatic cancer is quite high. These floaters must be removed by surgery.
Intraductal Papillary Mucinous Neoplasias (IPMN): These are cystic structures containing mucin that develop in the pancreatic ducts. Since those with certain characteristics have a high risk of turning into cancer, they may need surgery depending on their characteristics.
Solid Pseudopapillary Neoplasias: These tumors are found in young women. They grow very slowly and rarely spread. They must be removed by surgery.
Risk Factors for Pancreatic Cancer:
Risk factors are divided into two as modifiable and non-modifiable.
Modifiable Risk Factors:
>Tobacco and cigarette use – Increases the risk of pancreatic cancer by 2-3 times.
Obesity and obesity – People who are extremely obese have a 20% higher risk of developing pancreatic cancer.
Work Exposure to various chemicals on site - The risk may increase especially in those working in the metal and dry cleaning industry.
Unchangeable Risk Factors:
Age- Almost all patients are over 45 years of age. 2/3 of the patients are over the age of 65.
Gender- Pancreatic cancer was more common in men. However, the gap is closing as smoking rates in women approach men.
Race - It can be seen more frequently, especially in societies where obesity and smoking are more common.
Family History - Pancreatic cancer is more common in some families. It is known to be seen. Additionally, certain inherited genetic syndromes may be associated with pancreatic cancer. (Hereditary breast and ovarian cancers, Familial atypical mole melanomas, Familial pancreatitis, Lynch syndrome, Peutz-Jeghers syndrome, Von Hippel Lindau syndrome, Neurofibromatosis type I, Multiple Endocrine Neoplasia (MEN) type I)
Diabetes- Pancreatic cancer is more common, especially in patients with type 2 diabetes.
Chronic Pancreatitis- Chronic pancreatitis. It is the name given to long-term inflammation of the pancreas gland. Pancreatic cancer is more common.
Liver cirrhosis - The risk has been found to be increased.
Stomach problems - It is known that Helicobacter Pylori infection can increase the risk of pancreatic cancer.
The effect is not clear. Factors – Consumption of alcohol, coffee, red and processed meat, and physical inactivity are factors that are fully understood and investigated.
Diagnosis:
The most important tool used in diagnosis, besides blood tests, is radiological methods.
Ultrasonography - Although it is the imaging method that may cause the least harm to the patient, it is not always sufficient due to the location of the pancreas in the body. The experience of the radiologist performing the ultrasonography becomes important.
Endoscopic Ultrasonography (EUS): The pancreas is examined very closely by entering the stomach and duodenum with an endoscope equipped with an ultrasonography device at the end. It has a high diagnostic value because samples can be taken from masses and cysts.
Dynamic Pancreas MR or Dynamic Pancreas CT: Both methods are very valuable in the recognition of masses in the pancreas, evaluation of the spread of the masses and preoperative planning. It is the most important diagnostic tool in patients with a mass in the pancreas.
ERCP (Endoscopic Retrograde Cholangiopancreatigography) is important for evaluating the bile ducts, taking samples from suspicious masses, and eliminating jaundice in patients with obstructive jaundice.
Treatment
Treatment methods such as surgery, chemotherapy and radiotherapy are used as complementary treatments in the treatment of pancreatic cancer.
When deciding on treatment, the patient's age, life expectancy, tumor prevalence and accompanying diseases are taken into consideration.
p>
Surgery in Pancreatic Tumors
Surgery is the only curative treatment option that provides the patient with the best chance of survival in pancreatic cancer. Before the surgery, the patient is evaluated with imaging methods in terms of suitability for surgery. Portal vein, superior mesenteric vein and occasionally arterial system vein Involvement of the vessels that nourish the lungs is not an obstacle to surgery. In patients with this type of tumor involvement, it is possible to remove the tumor with advanced pancreatic surgery methods by making patient-specific planning.
Laparoscopic Pancreas Surgery
Laparoscopic (closed) Pancreas Surgery allows the patient to have smaller incisions and more It has become the preferred method especially for pancreatic body and tail tumors due to reasons such as less pain and short hospital stay. Laparoscopy and Robotic surgery are performed in selected cases of pancreatic head tumors.
Chemotherapy and Radiotherapy
It is used for complementary (adjuvant) or palliative purposes. It is sometimes applied as a preliminary treatment (neoadjuvant) in patients who are not suitable for surgery, and the patients are operated on after they become suitable for surgery.
Read: 0
